Rehabilitation Evidence > Autonomic Dysreflexia > Summary

Summary

Submitted by admin on Wed, 05/19/2010 - 09:25
  • There is level 4 evidence (from 4 pre-post studies) (Dykstra et al. 1988; Schurch et al. 2000; Chen et al. 2008; Kuo et al. 2008) that Botulinum toxin injections into the detrusor seem to be a safe and valuable therapeutic option in SCI patients who perform clean intermittent self-catheterization and have incontinence resistant to anticholinergic medications.
  • There is level 4 evidence (from 1 pre-post study) (Igawa et el. 2003) that intravesical capsaicin is effective for reducing episodes of AD in SCI.
  • There is level 1 evidence (from 2 RCTs) (Kim et al. 2003; Giannantoni et al. 2002) that intravesical resiniferatoxin is effective for reducing episodes of AD in patients with SCI.
  • There is level 1 evidence (from 1 RCT) (Giannantoni et al. 2002) that intravesical resiniferatoxin is more effective than intravesical capsaicin.
  • There is level 5 evidence that anticholinergics (from 1 observational study) (Giannantoni et al. 1998) are not associated with reduced incidence of AD episodes.
  • There is level 4 evidence (from one pre-post study and one case series study) (Hohenfellner et al. 2001; Kutzenberger 2007) that sacral deafferentation may be effective in preventing AD.
  • There is level 4 evidence (based on three pre-post/case series studies) (Barton et al. 1986; Sidi et al. 1990; Perkash 2007) that urinary bladder surgical augmentations may result in a decrease of intravesical and urethral pressure and diminish or resolve episodes of AD.
  • There is level 4 evidence (based on 1 case series) (Seoane-Rodriguez et al. 2007) that an intraurethral stent may be an effective means for the long-term management of detrusor-sphincter dysynergia for SCI patients, including those who have previously underwent sphincterotomy.
  • There is level 1 evidence (from 1 RCT) (Cosman & Vu 2005) that lidocaine anal block significantly limits the AD response in susceptible patients undergoing anorectal procedures.
  • There is level 1 evidence (from 1 RCT) (Cosman et al. 2002) that topical lidocaine does not limit or prevent AD in susceptible patients during anorectal procedures.
  • There is level 1 evidence (from 1 RCT) (Furusawa et al. 2008) that topical lidocaine may help to prevent AD during gentle bowel stimulation.
  • There is level 4 evidence that women with SCI may give birth vaginally. With vaginal delivery or when cesarean delivery or instrumental delivery is indicated, adequate anesthesia (spinal or epidural if possible) is needed.
  • There is level 4 and 5 evidence (from 2 case series and 2 observational studies) (Cross et al. 1992; Hughes et al. 1991; Cross et al. 1991; Showronski and Hartman 2008) that epidural anesthesia is preferred and effective for most patients with AD during labor and delivery.
  • There is level 5 evidence (from 2 observational studies) (Lambert et al. 1982; Eltorai et al. 1997) that indicate that patients at risk for autonomic dysreflexia are protected from developing intraoperative hypertension by either general or spinal anesthesia.
  • Anesthesiologists and surgeons dealing with SCI patients must know how to recognize the AD syndrome, how to prevent its occurrence and how to manage it aggressively.
  • There is level 1 evidence (from one RCT) (Matthews et al. 1997) supporting no effect of topical anesthetic for the prevention of AD during FES.
  • There is level 2 evidence (from 2 prospective controlled trials) (Steinberger et al. 1990; Lindan et al. 1985) that Nifedipine may be useful to prevent dangerous blood pressure reactions, e.g. during cystoscopy and other diagnostic or therapeutic procedures in SCI injured patients with AD.
  • There is level 5 evidence (from clinical consensus) (Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure 1997), that serious adverse effects from Nifedipine may occur and these have been reported in other populations.
  • There is level 5 evidence (clinical consensus) (Consortium for Spinal Cord Medicine 2001; Braddom & Rocco 1991), but no clinical studies which support the use of nitrates in the acute management of AD in SCI.
  • There is level 4 evidence (from one pre-post study) (Esmail et al. 2002) for the use of captopril in the acute management of AD in SCI.
  • There is level 4 evidence (from 3 pre-post studies) (Vaidyanathan et al. 1998; Swierzewski et al. 1994; Chancellor et al. 1994) that regular use of Terazosin may have positive effects on incontinence and AD.
  • There is level 1 evidence (from one RCT) (Krum et al. 1992), that Prazosin is superior to placebo in the prophylactic management of AD.
  • There is level 4 evidence (from one pre-post study and one case series study) for use of Phenoxybenzamine in the management of AD, however, the results are conflicting with no effects in one study (Lindan et al. 1985) and positive effects in another (McGuire et al. 1976).
  • There is level 2 evidence from a very small prospective controlled study (Frankel & Mathias 1980) which used subjects as their own controls which showed that the level of BP recorded during electrical ejaculation was substantially reduced with Prostaglandin E2.
  • There is level 2 evidence (from 1 RCT) (Sheel et al. 1995) that sildenafil citrate had no effect on changes in BP during episodes of AD initiated by vibrostimulation in men with SCI.